Application and Limitations of Hypothermia Therapy for Traumatic Brain Injury(<SPECIAL ISSUE>Traumatic Head Injury Update)

Abstrak. Latar Belakang Cedera kepala traumatik masih menjadi penyebab utama kecacatan dan kematian di dunia. Sebagian besar terjadi pada usia produktif. Efek sekunder dari cedera kepala adalah gangguan fungsi kognitif berupa fungsi memori, visuospasial, perhatian dan konsentrasi, bahasa, kalkulasi, dan orientasi. Masih sedikitnya penelitian tentang penilaian fungsi memori pada pasien cedera kepala di Indonesia. Tujuan Memaparkan gambaran penurunan fungsi kognitif terutama fungsi memori pada pasien cedera kepala derajat sedang dengan edema serebri.Metode Studi deskriptif dengan desain potong-lintang menggunakan kuesioner MMSE dan MoCA-INA sebagai modalitas penilaian.Hasil Dari 30 pasien cedera kepala traumatik derajat sedang didapatkan rerata skor MMSE adalah 27.1±2.13 (interval 20-29). Rerata skor MoCA-INA adalah 24.4±2.99 (interval 16-28). Kedua skor menunjukkan bahwa MoCA-INA memiliki rerata yang lebih rendah dan rentang skor yang lebih luas. Domain yang paling banyak terganggu adalah fungsi memori recall (98%)Kesimpulan Secara keseluruhan pasien dengan cedera kepala traumatik dengan edema serebri mengalami gangguan fungsi memori terutama area memori eksplisit berupa fungsi recall. Tatalaksana kuratif dan rehabilitatif secara adekuat dan berkelanjutan diperlukan untuk mempercepat proses penyembuhanKata Kunci Cedera Kepala Traumatik Derajat Sedang, Fungsi Memori, MMSE, MoCA-INAAbstract. Background Traumatic brain injury is still a major cause of disability and death. Most occur in productive age. Secondary effects of brain injury are impaired cognitive function in the form of memory, visuospatial, attention and concentration, language, calculation, and orientation. There are few research on the assessment of memory function in brain injury patients in Indonesia.Purpose To describes the decreasing cognitive function, particularly memory function in patients with moderate brain injury with cerebral edema.Method Descriptive study with cross-sectional design using MMSE and MoCA-INA questionnaires as assessment modalities.Results Of the 30 patients with moderate-grade traumatic head injury, the mean MMSE score was 27.1 ± 2.13 (intervals 20-29). The average MoCA-INA score is 24.4 ± 2.99 (intervals 16-28). Both scores indicate that the MoCA-INA has a lower mean and a wider score range. The most disturbed domain is recall memory function (96%)Conclusion Overall patients with traumatic brain injury with cerebral edema experience impaired memory function, especially the area of explicit memory in the form of recall function. Adequate and sustainable curative and rehabilitative management is needed to accelerate the healing process Keywords Traumatic Head Injury Moderate Level, Memory Function, MMSE, MoCA-INA

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Correlation between neutrophil lymphocyte count ratio and outcomes of severe traumatic head injury

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20214873 ◽

2021 ◽

Vol 9 (1) ◽

pp. 10

Author(s):

Tamajyoti Ghosh ◽

Subir Dey

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Head Injury ◽

Severe Traumatic Brain Injury ◽

Univariate Analysis ◽

P Value ◽

Traumatic Head Injury ◽

Neutrophil Lymphocyte Ratio ◽

Traumatic Head

Background: Raised peripheral neutrophil lymphocyte ratio is associated with poorer outcomes in conditions such as severe brain injury, ICH, cardiovascular conditions, cancer.Methods: Retrospective analysis of 96 severe Traumatic Brain injury data treated at our institute over a period of 1 year. The patients were followed up for a period of at least 1 month. The primary outcome of the study was 1 month GOS and the various variables which may be associated with the poor GOS at 1 month follow up. Model based analysis was done for NLCR <24 hrs at 48 hrs and GCS at the time of presentation and discriminative ability of the models were studied by the Area under the curve.Results: Univariate analysis were done of 96 patients of severe traumatic brain injury for various variables such as age, sex, mode of head injury, type of head injury, presenting GCS and NLCR at 24 hrs and 48 hrs to that of GOS at 1 month follow up. Initial GCS <7 (p=0.0138) with AUC=0.6689 and peak NLCR (<24 hr) of > 9.6 (AUC=0.931) with a p value of <0.001 with sensitivity of 100% and specificity of 79.27% and peak NLCR (48 hrs) of >12.4 (AUC= 0.973) with a p value of <0.001 with sensitivity of 100% and specificity of 89.02% were associated with unfavourable outcome.Conclusions: High NLCR and initial poor GCS are independent unfavourable prognostic factors in 1 month GOS following severe traumatic head injury.

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Outcome of traumatic head injury in unknown patients

International Surgery Journal ◽

10.18203/2349-2902.isj20180366 ◽

2018 ◽

Vol 5 (2) ◽

pp. 633

Author(s):

Ankit Ahuja ◽

Siddhartha Verma ◽

Aditya Narayan Chaudhary

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Head Injury ◽

Head Injuries ◽

Traumatic Head Injury ◽

Organ Systems ◽

Traumatic Head ◽

Gcs Score ◽

Discharge From Hospital ◽

Time Of Admission

Background: Traumatic brain injury is the most common cause of death in trauma victims accounting for about half of deaths at the accident site. Most commonly, traumatic brain injury occurs in the presence of additional injuries to other major organ systems, but it can also occur in isolation. Complications from closed head injuries are the single largest cause of morbidity and mortality in patients who reach the hospital alive. The objective of this study was to determine the outcome of traumatic head injury in patients admitted in the Department of Neurosurgery as unknown.Methods: All patients admitted as “unknown” to Neurosurgery department with traumatic head injury were studied retrospectively. Data was collected regarding demography, mode of injury, clinical presentation at the time of admission, management and outcome of these patients.Results: Data pertaining to 107 unknown patients were collected. Most patients were found to be males in 3rd decade of their lives with vehicular accidents as the common mode of injury. Patients presenting with Glasgow coma scale (GCS) score <8 at the time of admission had poor outcome and associated with higher mortality. Intra-cranial hemorrhage were predominantly found on CT scan. Only one-third of the patients were discharged after treatment while half of them suffered untimely death.Conclusions: Outcome of these neglected patients is poorer in comparison to patients who are accompanied by their relatives. Their management from pre-hospital to treatment and discharge from hospital is fraught with challenges. They need special care from trained nursing staff as well as help from social workers for recovery and rehabilitation.

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An Epidemiological Study of Traumatic Head Injury in a Tertiary Care Center in Kancheepuram, Tamil Nadu, India

Asian Journal of Medicine and Health ◽

10.9734/ajmah/2019/v16i130136 ◽

2019 ◽

pp. 1-5

Author(s):

K. Myl Kumaran ◽

Pragadeesh Raja ◽

M. Jasmine

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Head Injury ◽

Tamil Nadu ◽

Road Traffic ◽

Tertiary Care ◽

Major Public Health Problem ◽

Traumatic Head Injury ◽

History Of ◽

Traumatic Head

Introduction: Traumatic brain injury is a major public health problem in India. The severity of a traumatic brain injury may range from mild to severe. The increase in economic growth in India coupled with rise in population, motorization and industrialization has contributed to a significant increase in TBI with each advancing year. India having the highest rate of head injury in the world. In India more than 100000 lives are lost every year with over 1 million suffering from serious head injury. Objectives: To assess the risk factors among for head injury cases and assess the outcome of the traumatic brain injury patients. Materials and Methods: A cross sectional Study conducted among all patients with traumatic head injury attending tertiary care centre and those admitted in intensive care unit with the history of traumatic head injury for the duration of one year (August 2016 to July 2017). Data was collected through questionnaire, hospital records and collected from patients. Data Collected was entered in MS office excel and analyzed in SPSS version 21. Results: Totally 295 cases were reported with history of traumatic brain injury, out of which 82.7% were males and 17.3% were females. Road traffic accidents was the most common cause for TBI 86.4%. Most of the patient was between the age group of 21-40 (51.5%). Most of the cases were from rural areas 55.3%. Based on GCS 49.5%, 28.5% and 22.0% patients had mild, moderate and severe injury respectively. 44.7% injuries occurred between the time period 04.00PM to 12.00AM. Conclusion: This study revealed that most traumatic head injury occur due to Road traffic accident stressing the urgent need to create awareness and conduct health education about prevention of traumatic head injury.

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In Situ Hinge Craniectomy

Operative Neurosurgery ◽

10.1227/01.neu.0000255380.64969.81 ◽

2007 ◽

Vol 60 (suppl_4) ◽

pp. ONS-255-ONS-259 ◽

Cited By ~ 6

Author(s):

Kathryn Ko ◽

Scott Segan

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Bone Flap ◽

Normal Range ◽

Traumatic Head Injury ◽

Traumatic Head ◽

A Minor ◽

Refrigeration Storage ◽

Minor Procedure

Abstract Objective: To describe an optional method for performing decompressive craniectomy using in situ hinge craniectomy technique in patients with traumatic brain injury and stroke. Methods: Sixteen patients underwent surgery for treatment of presenting pathology followed by the placement of hinge craniectomy. The technique is detailed. Results: Six patients with traumatic head injury and 10 with stroke underwent treatment of their primary pathologies with subsequent hinge craniectomy. Of these patients, more than half underwent refixation of the hinge in a minor procedure after recovery. No patient had complications related to this technique and none required further cranial decompression. In patients with intracranial pressure monitoring, all displayed values in the normal range. Conclusion: In this limited study, in situ hinge craniectomy proved useful in the treatment of patients experiencing stroke or traumatic brain injury. This procedure has the potential to eliminate the additional second incision to explant the bone flap or the refrigeration storage of the bone flap. Also, the second operation to restore the cranial contour by reimplanting the bone flap or by the creation of a cranioplasty with artificial material would not be necessary.

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TP9.1.2We must do better - An audit assessing local compliance with NICE Guidelines (2014) on giving patient discharge advice regarding driving following traumatic brain injury

British Journal of Surgery ◽

10.1093/bjs/znab362.100 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Tarak Chouari ◽

Hamza Khan ◽

Umar Wali ◽

Arun Shanmuganandan

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Head Injury ◽

Patient Discharge ◽

Complex Activity ◽

Traumatic Head Injury ◽

Safe Driving ◽

Nice Guidelines ◽

Local Compliance ◽

Patient Advice

Abstract Introduction Driving is a complex activity involving the coordination of a number of cognitive and physical skills, which may be impaired after head injury. It is a legal requirement that patients’ inform the licensing authority when they have sustained a head injury. Failure to do so results in possible fines, invalid insurance and prosecution. NICE recommends printed patient advice about driving once discharged following a head injury. Methods A retrospective analysis of all traumatic brain injury admissions under the surgical team over a 6 months was performed. The aim was to identify current practice regarding assisting patients to return to safe driving after head injury. Information related to patient demographics, documented driving status and advice (verbal and written) related to driving, was sought. Descriptive statistics were used to portray the results. Results 56 patients were admitted following a traumatic head injury. The average age was 77 (range of 24 to 94) Patients spent on average 4 days in hospital. Only 2 patients had their driving status documented. These two patients also had a documented occupation dependent on driving. No patients received advice specific to DVLA guidelines. Conclusion This study demonstrates that there is poor compliance with NICE guidelines. Indeed, there is a need for change in our practice. We have a duty of care for our patients and in ensuring the safety of the general public. The main limitation of this study relates to the adequacy of documentation. We provide solutions in order to tackle the findings of this audit.

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